A型肉毒毒素声带注射治疗内收型痉挛性发声障碍的剂量与疗效研究

Dosage of Botulinum Toxin Injection and the Duration of Curative Effect in the Treatment of Adductor Spasmodic Dysphonia

施俊博;屈季宁;周涛;章薇;

1:武汉大学人民医院耳鼻咽喉头颈外科

在线阅读

摘要

目的探讨A型肉毒毒素声带注射治疗内收型痉挛性发声障碍的剂量和疗效维持时间。方法回顾性分析2003年9月至2017年10月间确诊并进行A型肉毒毒素声带注射治疗的79例内收型痉挛性发声障碍患者的临床资料,男11例,女68例,年龄1775岁,平均31.56±11.16岁,病程175岁,平均31.56±11.16岁,病程116年,平均5.03±4.29年。记录注射日期、剂量、次数及疗效维持时间,对其中连续注射超过10次的12例患者,分析第116年,平均5.03±4.29年。记录注射日期、剂量、次数及疗效维持时间,对其中连续注射超过10次的12例患者,分析第110次注的平均注射剂量变化趋势及疗效维持时间。结果 79例患者首次注射剂量510次注的平均注射剂量变化趋势及疗效维持时间。结果 79例患者首次注射剂量510u,平均6.28±1.57u,首次注射后疗效维持时间310u,平均6.28±1.57u,首次注射后疗效维持时间310月,平均4.53±1.62月。12例连续注射超过10次的患者每次注射剂量510月,平均4.53±1.62月。12例连续注射超过10次的患者每次注射剂量510u,平均5.8310u,平均5.838.54u,第18.54u,第110次注射剂量分别为5.83±1.63、8.43±2.20、7.75±1.72、8.12±1.55、8.54±1.28、7.92±1.79、8.02±1.25、7.92±1.79、7.29±1.67、7.19±1.69u;12例患者每次注射后疗效维持310次注射剂量分别为5.83±1.63、8.43±2.20、7.75±1.72、8.12±1.55、8.54±1.28、7.92±1.79、8.02±1.25、7.92±1.79、7.29±1.67、7.19±1.69u;12例患者每次注射后疗效维持310月,110月,110次平均维持时间分别为4.18±0.83、5.01±1.26、4.49±0.58、4.50±0.84、4.91±0.97、4.66±0.66、4.92±0.68、4.80±0.57、4.87±0.72、5.08±0.38月。结论 A型肉毒毒素单侧或双侧声带注射均能明显改善内收型痉挛性发声障碍患者的症状。本组连续注射10次以上的对象在第7次注射后平均注射剂量稳定于710次平均维持时间分别为4.18±0.83、5.01±1.26、4.49±0.58、4.50±0.84、4.91±0.97、4.66±0.66、4.92±0.68、4.80±0.57、4.87±0.72、5.08±0.38月。结论 A型肉毒毒素单侧或双侧声带注射均能明显改善内收型痉挛性发声障碍患者的症状。本组连续注射10次以上的对象在第7次注射后平均注射剂量稳定于78u,平均疗效维持时间为48u,平均疗效维持时间为46月。

关键词

痉挛性发声障碍;内收型;肉毒毒素;剂量;疗效

基金项目(Foundation):

湖北省自然科学基金项目(302-132449)

作者

施俊博;屈季宁;周涛;章薇;

参考文献

1 Hintze JM,Ludlow CL,Bansberg SF,et al.Spasmodic dysphonia:a review.part 1:pathogenic factors[J].Otolaryngology-Head and Neck Surgery,2017,157:551.

2 Hintze JM,Ludlow CL,Bansberg SF,et al.Spasmodic dysphonia:a review.part 2:characterization of pathophysiology[J].Otolaryngol Head Neck Surg,2017,157:558.

3 陈志鹏,葛平江.内收型痉挛性发声障碍元音音长及语长研究[J].临床耳鼻咽喉头颈外科杂志,2016,30:378.

4 O'Connell FA,Sataloff RT,Shewokis PA,et al.Socioeconomic variables of patients with spasmodic dysphonia:apreliminary study[J].J Voice,2017.

5 Sanuki T,Yumoto E.Long-term evaluation of type 2thyroplasty with titanium bridges for adductor spasmodic dysphonia[J].Otolaryngol Head Neck Surg,2017,157:80.

6 Lerner MZ,Lerner BA,Patel AA,et al.Gender differences in onabotulinum toxin A dosing for adductor spasmodic dysphonia[J].Laryngoscope,2017,127:1131.

7 Mor N,Tang C,Blitzer A.Botulinum toxin in secondarily nonresponsive patients with spasmodic dysphonia[J].Otolaryngol Head Neck Surg,2016,155:458.

8 Rosow DE,Pechman A,Saint-Victor S,et al.Factors influencing botulinum toxin dose instability in spasmodic dysphonia patients[J].J Voice,2015,29:352.

9 Murry T.Spasmodic dysphonia:let's look at that again[J].J Voice,2014,28:694.

10 Simonyan K,Tovar-Moll F,Ostuni J,et al.Focal white matter changes in spasmodic dysphonia:a combined diffusion tensor imaging and neuropathological study[J].Brain,2008,131:447.

11 Samargia S,Schmidt R,Kimberley TJ.Cortical silent period reveals differences between adductor spasmodic dysphonia and muscle tension dysphonia[J].Neurorehabil Neural Repair,2016,30:221.

12 Simonyan K,Ludlow CL.Abnormal activation of the primary somatosensory cortex in spasmodic dysphonia:an fMRI study[J].Cereb Cortex,2010,20:2749.

13 van Esch BF,Wegner I,Stegeman I,et al.Effect of botulinum toxin and surgery among spasmodic dysphonia patients[J].Otolaryngol Head Neck Surg,2017,156:238.

14 Chhetri DK,Berke GS.Treatment of adductor spasmodic dysphonia with selective laryngeal adductor denervation and reinnervation surgery[J].OtolaryngolClin North Am,2006,39:101.

15 DeConde AS,Long JL,Armin BB,et al.Functional reinnervation of vocal folds after selective laryngeal adductor denervation-reinnervation surgery for spasmodic dysphonia[J].J Voice,2012,26:602.

16 崔哲洙,金兰姬,姜宪.喉返神经甲杓肌分支与颈神经襻分支吻合术治疗痉挛性发声障碍一例[J].中华耳鼻咽喉科杂志,2002,37:67.

17 Tsuji DH,Chrispim FS,Imamura R,et al.Impact in vocal quality in partial myectomy and neurectomy endoscopic of thyroarytenoid muscle in patients with adductor spasmodic dysphonia[J].Braz J Otorhinolaryngol,2006,72:261.

18 黄永望,傅德慧.痉挛性发声障碍发病机制研究及治疗新进展[J].听力学及言语疾病杂志,2013,21:7.

19 Mendelsohn AH,Berke GS.Surgery or botulinum toxin for adductor spasmodic dysphonia:a comparative study[J].2012,121:231.

20 Fritzell B,Feuer E,Haglund S,et al.Experiences with recurrent laryngeal nerve section for spastic dysphonia[J].Folia Phoniatr(Basel),1982,34:160.

21 Namin AW,Christopher KM,Eisenbeis JF.Botulinum toxin dosing trends in spasmodic dysphonia over a 20-year period[J].J Voice,2017,31:107.

22 Lanzaro M,Petrone RD,Ambrosio A.Successful treatment with clozapine in a patient with neuroleptic-induced acute laryngeal dystonia[J].European Psychiatry,2001,16:261.

23 Rumbach AF,Blitzer A,Frucht SJ,et al.An open-label study of sodium oxybate in Spasmodic dysphonia[J].Laryngoscope,2017,127:1402.

24 Mor N,Simonyan K,Blitzer A.Central voice production and pathophysiology of spasmodic dysphonia[J].Laryngoscope,2018,128:177.

25 Mizoguchi K,Hatakeyama H,Yanagida S,et al.Perioperative complications and safety of type II thyroplasty(TPII)for adductor spasmodic dysphonia[J].Eur Arch Otorhinolaryngol,2017,274:2215.

26 Rojas G,Ricz H,Tumas V,et al.Vocal parameters and self-perception in individuals with adductor spasmodic dysphonia[J].J Voice,2017,31:391.

27 Tang CG,Novakovic D,Mor N,et al.Onabotulinum toxin a dosage trends over time for adductor spasmodic dysphonia:a15 -year experience[J].Laryngoscope,2016,126:678.

28 Chang CY,Chabot P,Thomas JP.Relationship of botulinum dosage to duration of side effects and normal voice in adductor spasmodic dysphonia[J].Otolaryngol Head Neck Surg,2007,136:894.

29 Birkent H,Maronian N,Waugh P,et al.Dosage changes in patients with long-term botulinum toxin use for laryngeal dystonia[J].Otolaryngol Head Neck Surg,2009,140:43.

30 Langeveld TP,Drost HA,Baatenburg DJR.Unilateral versus bilateral botulinum toxin injections in adductor spasmodic dysphonia[J].Ann OtolRhinolLaryngol,1998,107:280.

本文信息

PDF(254K)

本文关键词相关文章

痉挛性发声障碍内收型肉毒毒素剂量疗效

本文作者相关文章

施俊博屈季宁周涛章薇